City of Ballarat - Online Forms

Infringement Payment Plan

Council recognise that it has an ongoing social obligation to ensure vulnerable community members are treated with fairness, integrity and compassion. City of Ballarat is committed to working with the community to identify an appropriate payment solution that is effective and sustainable.

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Your Details

Full Name

Postal Address

Address Line 1

Address Line 2

Post Code

Contact Phone Number

Email (optional)

Your Details

Do you have one of these cards?

Yes

No

Centrelink Pensioner Concession Card

Centrelink Health Care Card Card

Veteran Affairs Pensioner Concession Card

Veteran Affairs Gold Card

Centrelink Customer Reference Number

CRN Expiry DateDD/MM/YYYY

Note: By providing your Centrelink details you authorise the City of Ballarat to perform a Centrelink enquiry of your Centrelink or Veterans’ Affairs customer details and concession card status in order to enable City of Ballarat to determine if you qualify for a payment plan or an extension of time.

Infringement Details

These infringements will be included in your payment plan:

Total

No infringements have been added to your list.

What type of infringement is it?

Parking

Animal

Litter or EPA

Local Laws

Other

Infringement Number

Vehicle Registration Number (optional)

Amount Due

Infringement added successfully

Application Details

What type of payment arrangement would you like to apply for?

Payment Plan

Extension of Time

Payment Plan

A Payment Plan is an agreement between Council and a community member which enables an infringement to be paid off in instalments at regular intervals.

Proposed Fortnightly Payment AmountYour proposed payment amount is less than the allowed minimum based on your total outstanding amount. If your application is approved the minimum amount may be more than what you have entered here.You haven't added any infringements to be included in your payment plan.

Proposed First Instalment Payment DateDD/MM/YYYYPlease enter a date at least 7 days from today.

Note: Failure to pay any instalment by the specified date will result in cancellation of the instalment plan which may lead to further costs and/or lodgement with the Infringement Court without further correspondence.

Extension of Time

An Extension of Time is an agreement between Council and a community member which provides the community member with additional time after the initial infringement or reminder notice due date to pay the infringement in full.

I would like to have an extension of time to pay and can make full payment onDD/MM/YYYYMust be no more than 3 months after the date of offence.

Declaration

I hereby undertake to comply with requirements of the City of Ballarat’s payment plan terms and conditions in accordance with the Infringements Act 2006.

The above information I have provided is true and correct to the best of my knowledge and I acknowledge that I am the offender listed on the infringement.

I also consent to City of Ballarat verifying Centrelink details provided above if applicable.

Collection Statement

Your personal information is being collected by City of Ballarat for the purpose of establishing a payment plan in accordance with the Infringements Act 2006. Your information will be stored in Council’s Customer Database and used to identify you when communicating with Council and for the delivery of services and information. For further information on how your personal information is handled, refer to Council’s Privacy Policy at www.ballarat.vic.gov.au/ac/privacy.aspx